Louisiana Statewide Needs Assessment
Dear Resident, 

Your local Louisiana Area Agency on Aging provides services and supports so that area residents can age successfully in the place they have chosen to call home. The priority of the local Area Agency on Aging is to treat all individuals with dignity and respect. By offering aging services, partnering with community agencies, and programs, the Area Agency on Aging both serves and empowers clients, their families and their caregivers to direct their own aging journey.

We are currently conducting a Needs Assessment to learn how we can best serve the community. We need your input to guide this process. 

Please take a few moments to complete the Needs Assessment by answering the questions below,  clicking the link provided, or if using a paper version of this survey, please complete the enclosed survey and return it via postal mail by October 15, 2026. We want to know the important priorities for you, your loved ones and your community.  All responses are anonymous.

We look forward to receiving your input!
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In what parish do you reside? 

If more than one place, enter the name of the parish where the residence in which you spend the most time is located:

 *

In what city do you reside? 

If more than one place, enter the name of the city where the residence in which you spend the most time is located: example: Lake Charles

 *

In what zip code do you reside? 

If more than one place, enter the zip code of the residence where you live the majority of the year:

 *

Please tell us your age: 

 *
Please indicate your answer on a Scale of 1 (Not Important) to 3 (Very Important) by selecting the radio button below the number.
How important is: 
 *
1 Not Important
2 Important
3 Very Important
Having access to the Internet?
Knowing what services are available for seniors and how to access the services?
Information or help applying for health insurance or prescription coverage?
Transportation to the Senior Center, store, doctor's office, pharmacy, or other location?
Having a meal with a friend or others my age?
Please indicate your answer on a Scale of 1 (Not Important) to 3 (Very Important) by selecting the radio button below the number.
How important is: 
 *
1 Not Important
2 Important
3 Very Important
Learning computer basics, how to use the internet or other skills?
Participating in fun group activities (e.g. day trips, exercising, dancing, walking, crafts, music, Bingo, etc.) with others my age?
Having someone to talk to when I feel lonely?
Having someone deliver a meal to my home every day?
Please indicate your answer on a Scale of 1 (Not Important) to 3 (Very Important) by selecting the radio button below the number.

How important is: 
 *
1 Not Important
2 Important
3 Very Important
Information on healthy eating to maintain physical health and overall well-being?
Help keeping my home clean?
Help with personal care (bathing, dressing, eating meals, taking medicine, etc.)?
Information, service and support for mental health issues (Alzheimer's, Dementia, Depression and other Disorders of the brain)?
Keeping warm or cool as weather changes?
Please indicate your answer on a Scale of 1 (Not Important) to 3 (Very Important) by selecting the radio button below the number.

How important is: 
 *
1 Not Important
2 Important
3 Very Important
Preventing falls and other accidents?
Having a Senior Center that is close to my home?
Respite Care Service (short-term relief service provided in your own home to give caregivers a break)?
Access to Respite Care Facilities (Licensed Adult Residential Care Homes for assisted independent living)?
Help with senior housing or assisted living?
Help with bill payment/budgeting?
Help with substance cessation (alcohol/drugs/smoking)?
Access to dental, eye, or hearing care?
Help with rental or energy assistance?
Help completing Medicare/insurance forms
Which of the following do you experience hardships affording and would obtain financial assistance to pay, if available? Check all that apply: *
I often need help paying this.
I do not need help paying this.
Dental Care and/or Dentures
Hearing Exam and/or Hearing Aids
Eye Exam/Glasses
Health Insurance
Healthy Food
Medicare
Prescriptions or prescription drug coverage
Other Assistive Medical Devices
CAREGIVERS
The following questions pertain to caregivers and those for whom they care. If you do not care for anyone, please select N/A.
If you care for an Older Adult aged 60 years or older, please tell us how much you agree with each of the following statements. Which of these statements apply to you? Indicate your level of agreement by selecting: 
1: Disagree
2: Neutral
3: Agree
4: N/A (I do not care for an older adult). 
 *
1 =Disagree; 2=Neutral; 3 = Agree; 4=N/A(I do not care for an older adult)
1: Disagree
2: Neutral
3: Agree
4: N/A
I need help paying for services needed by the person I care for
I need help locating services for the person I care for
I would like training on caring for someone at home
I need a place for the person I care for to go during the day
I sometimes need temporary relief from my caregiver duties (respite)

CAREGIVERS: Of the persons you care for, how many of those are:

 *
1 Person
2 people
More than 2 People
N/A: Not a caregiver
Column 5
Over 60 years old
Disabled
Both Over 60 years old and disabled
Child/Children under Age 18
Race and Ethnicity (Listed in alphabetical order)
As our country becomes more racially and ethnically diverse organizations bear a responsibility to be inclusive and pursue equity.

Which of the following best describes you?
Please select all that apply:
 *
Required
Gender Identity:
We strive to create programs and services that represent and serve the full diversity of the community. 
We are asking the following questions about gender, gender identity and sexual orientation to ensure that we are meeting this goal.
Which of the following best describes you?
Select all that apply:
 *
Required
Do you identify as a member of the LGBTQIA+ community?:
 *
Disability Status:
We strive to create programs and services that represent and serve the full diversity of the community. 
We are asking the following questions about disability to ensure that we are meeting this goal.
Disability Status:
Do you have a long-lasting or chronic condition (such as physical, visual, auditory, cognitive, emotional or other) that requires ongoing accommodations for you to conduct daily life activities (such as your ability to see, hear or speak; to learn, remember or concentrate)? *
Disability Status:
We are interested in this data regardless of whether you typically request for/ use accommodations? 

How do you describe your disability status?  (Select all that apply) *
Required
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